Report on Reproductive Health of Chinese Women of Childbearing Age Reveals Less Than 60% Seek Medical Care Despite High Symptom Prevalence

The number of women of childbearing age in China is declining.

Recently, the National Bureau of Statistics released China’s 2021 demographic data. Over the past year, the natural population growth rate stood at 0.34 per thousand, representing a decline of 1.11 percentage points compared with 2020. At the subsequent press conference, Yang Jinrui, Deputy Director of the Department of Population and Family Development under the National Health Commission, pointed out that the shrinking size of the childbearing-age female population was a major factor driving the decrease in the number of births. For instance, the number of women aged 20–34, who are in their peak childbearing years, fell by 4.73 million in 2021 compared with 2020.

The fluctuation in the number of women of childbearing age is a dynamic outcome of long-term societal development and cannot be altered in the short term. Against this backdrop, enhancing the reproductive health literacy of existing women of childbearing age and their knowledge mastery regarding the first 1,000 days of life holds significant importance for both individual well-being and the sustainable development of society.

“Reproductive Health” The concept of “reproductive health” first emerged in the 1960s. The World Health Organization defines it as a state of complete physical, mental, and social well-being in all matters relating to the reproductive system and its functions and processes throughout the life course, not merely the absence of disease or infirmity. Previous surveys have indicated that women of childbearing age in China face issues such as insufficient knowledge of reproductive health and high prevalence rates of common gynecological disorders.

The first 1,000 days of life focus more on the infant and toddler stage, referring to the period from conception to two years of age. During this time, fetal tissues and organs begin to form, and the brain develops rapidly. This period is defined by the World Health Organization (WHO) as a “window of opportunity” for growth and development. Therefore, nutritional supplementation and related knowledge during this period are particularly important for improving the health of women of childbearing age and enhancing population quality.

Based on this, Healthbound News, in collaboration with the Institute of Health Communication at Fudan University, launched an industry survey titled “Reproductive Health of Women of Childbearing Age in China.” Bayer China, which focuses on health management across women’s entire life cycle and has long been committed to empowering Chinese women of childbearing age to improve their health literacy, provided pro bono support for this survey.

Scan the QR code to download

Research Report on the Reproductive Health of Women of Childbearing Age in China

(2022)

This survey was conducted in the form of an online questionnaire, with a total of participants from across China31provinces (municipalities, autonomous regions) of3153named women of childbearing age (15-49years old) participated.Among them,20-39The proportion of women aged [X] and above exceeds9Complete.Among all respondents, the total number of individuals who were trying to conceive, pregnant, or breastfeeding postpartum was952people, accounting for % of the total population30.2%。

The survey covers the current status of knowledge regarding reproductive health, physical and mental health conditions, lifestyle factors, reproductive history, and demographic characteristics, aiming to provide evidence for relevant authorities in formulating policies.

The current state of reproductive health among women of childbearing age in China is one of the key focuses of this survey.

Survey data show that among 3,153 respondents, 70% reported gynecological symptoms. Menstrual-related symptoms were the most commonly self-reported by women, accounting for 50.8%, with main manifestations including irregular menstrual cycles, dysmenorrhea, and abnormally heavy menstrual bleeding. Other relatively common conditions included other gynecological symptoms and breast-related symptoms, with self-reported prevalence rates of 30.2% and 20.5%, respectively.

Image provided by Ba Dian Jian Wen

Chen Rong, a chief physician in the Department of Obstetrics and Gynecology at Peking Union Medical College Hospital, has long been engaged in public education on reproductive health. In her view, menstruation serves as a barometer of women’s health; therefore, medical attention is necessary if one experiences prolonged menstrual periods, abnormal menstrual flow, or pain that exceeds physiological tolerance.

“Persistent amenorrhea and irregular menstrual cycles may indicate polycystic ovary syndrome (PCOS). Severe dysmenorrhea could be a manifestation of endometriosis or adenomyosis. Menstrual irregularities are an indicator of women’s health. Women should pay attention to and understand their bodies, monitor any changes, and seek medical attention promptly if issues arise—never ignore them.”

Gynecological symptoms emphasize the subjective experiences of respondents, whereas gynecological diseases more accurately reflect objective clinical findings. Among respondents who reported gynecological symptoms and sought medical care, approximately two-thirds were diagnosed with gynecological diseases. The top three conditions were vulvovaginal candidiasis, mammary gland hyperplasia, and pelvic inflammatory disease, with prevalence rates of 23.8%, 18.6%, and 14.2%, respectively (this prevalence refers to the proportion of gynecological diseases among individuals who sought medical attention due to related symptoms).

Another interesting finding relates to age. In this survey, women of childbearing age aged 30–39 had the highest prevalence of gynecological symptoms among all age groups, at 72.3%.

Jiang Hong, a professor at the School of Public Health of Fudan University and a committee member of the Women’s Health Branch of the Chinese Preventive Medicine Association, believes that this is partly because individuals aged 30–39 are in their peak reproductive years with relatively active sexual lives, making them more susceptible to infections. It is also related to the emotional state of women in this age group. “Women in this age bracket often bear multiple pressures from childbearing, family caregiving, and work. These pressures translate into anxiety, which can disrupt the secretion of gonadotropins by the brain and impair ovarian function, leading to a series of endocrine disorders—all of which have been scientifically confirmed.”

Reproductive health encompasses not only physiological aspects but also psychological well-being. In particular, women in the periconceptional period during the first 1,000 days of life often experience significant stress.

This survey assessed prenatal stress levels among women with a history of preconception planning, pregnancy, and childbirth. Stress was measured on a scale from 0 to 9, with higher scores indicating greater stress. The results showed that over 60% of participants scored between 6 and 8. Only 2.7% of respondents reported experiencing no stress at all. Among all stressors, “concerns about the baby’s health at birth” and “concerns about safe delivery” were the most frequently cited.

Another important dimension of this survey is the level of reproductive health awareness among women of childbearing age in China.

In the survey, to more accurately reflect the actual situation, the questionnaire divided “reproductive health awareness” into two parts: “obstetrics and gynecology knowledge” and “health knowledge for the first 1,000 days of life,” with questions designed separately for each part to calculate scores.

In the "Obstetrics and Gynecology Knowledge" section, a total of 20 questions were included, with a maximum score of 100 points. The majority of respondents scored between 55 and 70 points, accounting for approximately 60% of the total participants. This indicates that while most women of childbearing age have an acceptable grasp of obstetric and gynecological knowledge, there remains significant room for improvement.

In terms of the accuracy rate for individual questions, the highest correct response rate was 90.2% for the statement: “Induced abortion, particularly repeated abortions, causes significant harm to women’s health and fertility, potentially leading to complications such as secondary infertility.” The lowest correct response rate was 26.8% for the statement: “Hepatitis B can be transmitted through sexual contact,” with the majority of respondents incorrectly considering this statement to be false.

In the “First 1,000 Days of Life Health Knowledge” section, which also featured a design of 20 questions for a total of 100 points, the average score was significantly higher than that of the “Obstetrics and Gynecology Knowledge” section, with 80% of participants scoring above 60.

The statement with the highest correct response rate was “Actively undergoing preconception checkups and early screening is an effective method for preventing birth defects,” achieving a correctness rate of 94.6%. The item with the lowest correct response rate concerned the appropriate dosage for folic acid supplementation. Over 90% of respondents believed that a daily intake of 0.2–0.4 mg of folic acid or a multivitamin containing this dosage was sufficient. However, according to the folic acid intake recommendations in the Guidelines for Preconception and Prenatal Care issued by the Chinese Medical Association, the recommended daily supplementation is 0.4–0.8 mg of folic acid or a folic acid-containing multivitamin. This question also had the lowest correctness rate in the current survey.

The second most frequently answered incorrectly also pertained to nutritional supplementation, with 63.5% of respondents erroneously believing that consuming large amounts of bone broth helps supplement calcium. In fact, the calcium in bones exists in the form of phosphate, which is insoluble in water; therefore, cooking methods such as stewing cannot dissolve calcium into the broth. There is no scientific basis for the claim that drinking bone broth supplements calcium. The "Guidelines for Preconception and Prenatal Care of the Chinese Medical Association" recommend starting from the 14th week of pregnancyStart by supplementing with 0.6–1.5 g of calcium daily, and consider choosing organic calcium formulations that are more suitable for use during pregnancy.

A comparison of the two questionnaire sections reveals that women of childbearing age demonstrate a moderate improvement in their acquisition and mastery of relevant knowledge after the first 1,000 days of life. This is particularly evident in qualitative aspects; for instance, most individuals recognize the importance of ensuring adequate nutritional intake. However, there remains a lack of quantitative understanding regarding the specific timing and dosage of nutrient supplementation.

Jiang Hong believes that, from the perspective of health awareness, achieving a qualitative understanding is the first step, and one should not be overly demanding in terms of quantification. Taking folic acid as an example, the recommended dosage for supplementation varies among women with different reproductive histories. Women with a history of adverse pregnancy outcomes, such as birth defects, require a higher dose of folic acid than those without such a history. “We can promote public health education to inform people about the need for folic acid supplementation and the minimum daily intake required. However, for each individual, personalized recommendations should be provided based on their specific circumstances and in accordance with medical advice.”

Jiang Hong also cautioned that when addressing nutritional supplementation, it is important to recognize the disparities between urban and rural areas, as well as between developed and less-developed cities. Currently, the nutritional intake of women during the periconceptional period in Shanghai is relatively adequate. However, in other less-developed regions, particularly rural areas, nutritional supplementation for women in the periconceptional period may still be insufficient.

Surveys indicate that against the backdrop of a high prevalence of gynecological symptoms, the proportion of women of childbearing age in China who proactively engage in health management behaviors is significantly low, with a substantial number opting for self-care rather than seeking hospital-based medical attention.

Among all respondents, as many as 70.6% of women reported experiencing at least one gynecological symptom in the past year. Of these, 57.8% sought medical attention, and among those who consulted a physician, 64.4% were diagnosed with a gynecological disorder. A considerable proportion of women opted against hospital visits and instead chose self-management; specifically, 51.3% used oral or topical medications to alleviate their symptoms.

The consequences of delayed diagnosis and treatment are catastrophic. Dr. Chen Rong once encountered a case involving a woman in her thirties who experienced frequent bleeding outside of her menstrual period for over a year, yet continually postponed seeking medical attention. By the time she finally visited the hospital for examination, her cervix had assumed a flame-shaped appearance, and she was ultimately diagnosed with advanced-stage cervical cancer. “This case has always been deeply distressing to me. In fact, if she had come to the hospital even slightly earlier, we would have had numerous effective treatment options available.”

Jiang Hong believes that women’s tendency to endure gynecological issues is closely related to the lack of support and care from the social environment. “From school to the workplace, no special accommodations are made for women during their menstrual periods. This is an area where we fall short, making it impossible for them to take monthly leave to spend half a day or a full day seeing a doctor, even when they experience discomfort.”

Jiang Hong stated that this is also corroborated by survey findings, with vulvovaginal candidiasis ranking as the most commonly diagnosed gynecological condition among women. This condition causes extreme discomfort; severe itching can lead to restlessness and disrupt sleep and appetite. In cases of more severe reproductive tract infections, dysuria may also occur. “In most cases, patients only seek medical attention when the symptoms become unbearable.”

Health behaviors serve as the link between health literacy and health status. Generally, a higher level of health literacy makes it easier to adopt healthy behaviors, thereby improving health status.

This finding is also reflected in the survey. Based on a comparative analysis of multiple data points, the report concludes that women with gynecological symptoms are only 50% as likely to have a good grasp of health knowledge as those without such symptoms. Furthermore, among symptomatic women who did not seek medical care, the likelihood of possessing adequate health knowledge was 68% of that observed in those who did seek care. In other words, the absence of gynecological symptoms and the behavior of seeking medical attention when symptomatic are significantly associated with a robust knowledge base. This suggests that individuals with strong obstetric and gynecological health literacy are better equipped to prevent gynecological diseases and are more inclined to seek medical care to address their health concerns.

The Importance of Reproductive Health Is Gaining Social Recognition.

“Healthy China Action (2019–2030)” explicitly states that maternal and child health is the foundation of health for all. Implementing actions to promote maternal and child health is a significant measure to safeguard the health rights and interests of women and children, foster their comprehensive development, and maintain reproductive health, thereby helping to improve the national health level from its source and foundation.

Important, yet easily overlooked. Jiang Hong stated that, on one hand, families and schools remain deeply reticent about adolescent sex education, leading many patients to develop latent reproductive health risks during puberty. On the other hand, society, enterprises, and healthcare institutions have paid insufficient attention to providing “patient-centered” reproductive health services, objectively creating barriers for women seeking medical care in this field.

“A simple example is gynecological examinations. You know that most women in China are reluctant to undergo such exams, often experiencing feelings of helplessness or even fear. To change this situation, I believe healthcare institutions have much they can do—improving reproductive health services, creating a supportive environment, ensuring privacy protection, providing proactive care, and offering humanistic compassion. In these regards, we still have a long way to go.”

Regardless of how the external environment changes, returning to the essence of the issue—which is also the core of this survey—reveals that women’s own reproductive health literacy has a decisive impact on their reproductive health status. Based on this conclusion, improving women’s reproductive health literacy becomes the key to addressing the challenge.

The report proposes the following countermeasures and recommendations: tailor reproductive health education content to address specific issues such as sexually transmitted infections, contraceptive methods, and essential nutritional supplementation; prioritize populations with limited knowledge of reproductive health, including those with low income (monthly income below RMB 3,000), rural household registration (hukou), and lower educational attainment (high school level or below); and actively promote healthy lifestyles, such as increasing dietary intake of fruits and vegetables and engaging in regular physical exercise.

Ma Caihong, Deputy Director of the Center for Reproductive Medicine at Peking University Third Hospital, concurred with this view, placing particular emphasis on the importance of science popularization. “Our science education efforts in reproductive health remain far from sufficient. Due to the inherently private nature of this field, access to authoritative information and knowledge is still relatively limited. Nevertheless, the focus of prevention and treatment in reproductive health is shifting from disease management to prevention, and toward lifecycle-oriented health management—a transition that relies heavily on substantial investment from both the government and society.”